OBJECTIVE Cardiometabolic index (CMI), calculated as the product of waist-to-height ratio and triglycerides-to-HDL cholesterol ratio, has been proposed as a discriminator of diabetes and has been reported to be associated with progression of atherosclerosis. The purpose of this study was to determine the relationship between alcohol drinking and CMI in men with diabetes. METHODS The subjects were Japanese male workers aged from 35 to 65 years with diabetes mellitus (n = 1411). The subjects were divided by average daily alcohol consumption (g ethanol/day) into 4 categories of alcohol drinking (nondrinkers; light drinkers, < 22; moderate drinkers, ≥ 22 and < 44; heavy drinkers, ≥ 44). CMI and variables comprising CMI were compared in the nondrinker and each of the drinker groups. Age, habits of smoking and regular exercise, and a present history of medication therapy for diabetes were adjusted in each analysis. RESULTS Log-transformed CMI was significantly lower in light and moderate drinkers than in nondrinkers. Waist-to-height ratio was significantly lower in moderate drinkers than in nondrinkers, while log-transformed triglycerides was significantly higher in heavy drinkers than in nondrinkers. HDL cholesterol tended to be higher with an increase of alcohol consumption. Odds ratios with their 95% confidence intervals vs. nondrinkers for high CMI were 0.53 (0.36-0.78) in light drinkers, 0.61 (0.46-0.80) in moderate drinkers, and 0.74 (0.55-1.00) in heavy drinkers. CONCLUSIONS In men with diabetes, CMI is lower in light-to-moderate drinkers than in nondrinkers, and this results mainly from a positive association between alcohol drinking and HDL cholesterol.